23 Connecticut hospitals penalized for high readmission rates; Middlesex will face no penalty

Lisa Chedekel

Published
12:00 am EDT, Tuesday, August 14, 2012

Twenty-three Connecticut hospitals will forfeit Medicare funds in the next year under a new federal policy that penalizes hospitals with significant numbers of patients who are readmitted within a month of discharge.

The 23 Connecticut hospitals are among more than 2,200 nationwide that will be penalized by the federal government, starting in October, under provisions in the 2010 federal health care law. A total of 278 hospitals nationally will lose the maximum amount allowed; others will lose fractions of 1 percent of their Medicare funding.

Federal officials have been concerned about 30-day readmission rates for patients who are hospitalized for three conditions: pneumonia, heart attacks and heart failure. The health reform legislation allows CMS to withhold a portion of Medicare payments to hospitals that have excessive readmissions, starting with up to 1 percent in fiscal year 2013 and rising to 3 percent in 2015--penalties that could reach millions of dollars for some hospitals.

Because the penalties are based on readmissions between July 2008 and June 2011, officials of many Connecticut hospitals said they had anticipated losing some Medicare funding. Most hospitals in the state have committees working on initiatives to reduce readmission rates, with a focus on improving the transition from inpatient to community care.

At St. Raphael's, which is merging with Yale-New Haven, Jim Judson, director of quality improvement said in an earlier interview that an interdisciplinary team is working to improve the transition to post-hospital care and is providing patients with easy-to-understand information about the symptoms and care of pneumonia and heart conditions.

Judson and other administrators have noted that inner-city hospitals often treat patients with co-morbid conditions that can land them back in the hospital after discharge. Readmissions are counted no matter why the patient returns within 30 days. That means if a patient discharged after treatment for pneumonia returns to the hospital within 30 days with a broken hip, the new admission is counted against the hospital.

Nationally, about 20 percent of hospitalized Medicare patients are back within 30 days, at an estimated cost of $17 billion a year, according to the Medicare Payment Advisory Commission.

Some health care experts have said they expected hospitals that serve large numbers of low-income people to be hit hardest by the penalties, because of problems ensuring that patients follow through with doctors and medication after discharge. A number of such hospitals show up among the 278 that received the maximum penalty, including St. Elizabeth's Medical Center in Boston and Montefiore and Maimonides medical centers in New York.